House Passes SGR Patch
Written by Editor   
Friday, March 28, 2014 12:00 AM

The U.S. House of Representatives voted on Thursday, March 27, 2014, to pass a bill that would prevent a twenty-four percent cut in reimbursements for physicians treating Medicare patients by enacting another temporary 12-month patch.  This represents the 17th time Congress has stepped in with a temporary fix to Medicare's flawed Sustainable Growth Rate (SGR) formula.

The one-year "doc fix" comes in lieu of a long-term proposal to permanently repeal and replace the SGR formula due to Congress' inability to come to an agreement on how to pay for the 10-year, $140 billion replacement measure.

The compromise measure contains several additional health care provisions and benefits, including granting Medicare physicians a 0.5 percent update through December 31, 2014, and a zero percent update from Jan. 1, 2015, through March 31, 2015, as well as at least a one-year delay nationwide for the conversion from ICD-9 to ICD-10 coding under the Medicare program.  Lawmakers voted to delay the switch to the ICD-10 coding system until October 1, 2015.

The U.S. Senate is now scheduled to take up the House-approved bill on Monday, March 31--the same day the current 3-month "doc fix" extension expires. Because legislation has not yet been passed by Congress to avert the negative update to Medicare physician payments, the Centers for Medicare and Medicaid Services (CMS) announced today that it has instructed all Medicare Administrative Contractors (MACs) to hold claims containing services paid under the Medicare Physician Fee Schedule (MPFS) for the first 10 business days of April (i.e., through April 14, 2014). This hold would only affect MPFS claims with dates of service of April 1, 2014, and later.

All claims for services delivered on or before March 31, 2014, will be processed and paid under normal procedures, regardless of any Congressional actions.

ACA's Government Relations Department will continue to closely monitor the actions taken on Capitol Hill and will provide additional information in the near future. If you have questions, please email [email protected].